Your Aetna experience?

kuchiegrl1 · 01-31-2008, 12:58 PM

Okay so here is the scoop.

Did the 6 month supervised diet, nutritionist, pysh eval, 5 yr hx of obesity 48% bmi. Got the approval in Sept 07. Had my surgery Nov 26th, 07. Paid my 20% co-insurance (around 1000.00). Now........I have received a bill from the anesth. for 20% of his bill? And also now Aetna is putting all the other bills (surgeons) under clinical review? So now 6000.00 is pending. What in the hell is this mean to me????)*%#W!#

I have an approval letter from aetna for the surgery. I tell you what, I called aetna today and of course all i could get from them was, I am sorry but this is under review, no I cant tell you if you will owe money.......holy crap can they really go back on their approval letter?

I am so flippin mad with this insurance scam crap. Why cant this country go to socialized medicine like so many other well-adapated countries.....grrrrrr

Has this happened to anyone else out there....feedback would be greatly appreciated.

coolcrystal · 01-31-2008, 01:03 PM

I just got approved through Aetna POS. I work with Verizon, so it's insurance through them. My company is big time into health and I even have a fitness center at my job.. so, it wasn't a shock when I found out they support the surgery which I think that's why it went pretty smooth. All my paperwork was submitted on 1/22 and I just got approval today on 1/31. It took 8 days.

Also, the lady who submitted all my stuff said she put on the paperwork that I had a surgery date of 2/4 and even though that was a big lie, she thinks that's what got them to hurry up and approve me quicker. She said they realized they needed to get the approval done quickly for my surgery. LOL. So, now I should be able to get it done in February.

I can't tell you how happy I am. This has been a 7 month long journey for me. Six months of doctors appointments, a psych evaluation that cost me 400 buckaroos and was pointless and seeing the dietician who told me everything I already knew from this forum , etc... but, it finally happened.

I wish you all the best of luck!!

coolcrystal · 01-31-2008, 01:07 PM

Quote:

Originally Posted by kuchiegrl1

I am so flippin mad with this insurance scam crap. Why cant this country go to socialized medicine like so many other well-adapated countries.....grrrrrr

Has this happened to anyone else out there....feedback would be greatly appreciated.

Sorry, i couldn't help but read this; I'm sorry Aetna is screwing you over like this. But fight it... you shouldn't have to pay for all that other stuff.

But, I disagree with the socialized medicine part of what you said. If you look at other countries, like UK and Canada who have socialized medicine, obese people are completely left out and neglected... You would not easily get this surgery there. They could care less about obese people. Socialized medicine is the worst thing... most people wait months for an appointment and die waiting for cancer treatments too... Socialized medicine is not what we need.

miss meliss · 01-31-2008, 03:04 PM

Con-grats!
I have been watching your posts and I am so happy for you!!
I am going thru the 12 weeks surpervised diet right now. I live in Burleson and have a POS II also, so I am happy things have worked out for you. Who is your Doctor??

I agree on the Socialized Medicine. When my dad had cancer, he went to MD Anderson in Houston. Lots of UK and Canda people there to get help that wasn't possible in their country.

Yehaw, back at y'all!!

skculpepper · 01-31-2008, 03:07 PM

Dr. Marsden, he is wonderful!! Good Luck!!

dwh · 01-31-2008, 04:31 PM

The paper work for me and my wife was submitted on 1-28 and we got approved today and we are to use Dr Marsden. We will have the surgery in Austin .True Results took care of all paper work just went to them for 12 weeks. I was really afraid that it was going to be a problem having Atena just did what they wanted.

destiny79 · 01-31-2008, 05:04 PM

I also had True Results of Fort Worth and had my surgery with Dr. Marsden you will love him he know his job very well!!!!

lonestar5212 · 01-31-2008, 06:15 PM

dwh - You got approval in three days? Fantastic!! True Results was submitting my stuff to Aetna "this week." Not sure what day. I am on pins and needles. Congratulations to you and your wife. Best wishes on the surgery.

coolcrystal · 01-31-2008, 08:42 PM

Quote:

Originally Posted by miss meliss

Con-grats!
I have been watching your posts and I am so happy for you!!
I am going thru the 12 weeks surpervised diet right now. I live in Burleson and have a POS II also, so I am happy things have worked out for you. Who is your Doctor??

I agree on the Socialized Medicine. When my dad had cancer, he went to MD Anderson in Houston. Lots of UK and Canda people there to get help that wasn't possible in their country.

Yehaw, back at y'all!!

Awee, thank ya very much!! My doctor is Dr. Fox, who works in the True Results in Dallas. My friend used him and has lost over 100 pounds now, and I did research on him and liked what I saw. But, I hear lots of good stuff about Marsden too, so I'm sure if you used him he would be good for ya too. There's lots of great doctors in the D/FW area to use.

tmarie07 · 02-01-2008, 12:34 AM

Same thing with me - The doctor/surgery center bill is "pending approval" because they want more records from the doc...uh, hello...he gave you enough to approve the surgury! But I'm sure this is just how they operate to make it a more annoying process for all because they look for any way to get out of it and delay it. I'm sure they'll pay that part eventually.

Now, I did get paperwork saying they've denied the anesth completely showing me as owing $1600 to him - I'll wait a few weeks and see what happens because again, pretty normal with insurance companies. His people will probably get it pushed through and approved, and if not, I'll call and argue with insurance, because again, they approved the doc, they assigned me WHERE I could have it done, and NOW you're telling me that the anesth that location uses isn't covered? Like I could know that. Should I have asked EVERY person I saw that day if they were accepting Aetna. No.
With an previous insurance company I had to have a CAT scan, and while the hospital it was in was in network, they didnt consider the person the HOSPITAL sent the test results to to be in In Network. Once I reviewd with them that I had no control over who they sent it to, as I'd assumed it was all in house since it was a hospital, they agreed that a patient can't always have a say in who a hospital/etc sends things out to. The gal acted as though this was common practice to get these calls and to "fix" them to be covered.
So don't worry, give it a month and see if anything changes. And remember, the doctors office wouldnt have done the surgery without cash upfront if insurance hadn't of approved it, so they're used to working this stuff out. So absolute worst case scenario, if it can't be approved for some insane reason, they'll work out payments with you. And I doubt they'll "take the band back!".

Tina

tmarie07 · 02-01-2008, 12:37 AM

True Results was great in getting all the paperwork together - although they did have some hiccups with mine, as they couldnt seem to figure out if I was considered Lap Band Solutions patient, or their patient, so there was some conflicting info there, but once they got that sorted, it was all good. I'm sure that doesnt happen often! In submitting the paperwork, they seem to be very thorough and leave no stone unturned!

Good luck to those waiting on approval!

lonestar5212 · 02-01-2008, 07:35 AM

About 4 years ago my daughter had surgery, not Lap Band, but we had the same thing happen with the anethesiologist's charges. I simply called them and said, just what you said outloud. If you approve the surgery, and the surgery center, how in the world would I know that the anthesiologist would not be to your liking? They told me I would not have to pay it. It was Aetna POS II.

Also, I used a surgeon in the same practice with Dr. Marsden (he left that practice last July to focus on Lap Band), but he had an excellent reputation here in town, and with my friend who was a nurse at the hospital where Dr. Marsden worked at the time. She gave me an excellent report on him. So I feel very comfortable with my choice of him for my Lap Band surgery.

My paperwork submitted to Aetna this week, so I am waiting to hear.

JDUB0414 · 02-01-2008, 07:43 PM

lonestar good luck.

coolcrystal congrats.

SpecialK · 02-01-2008, 08:10 PM

I called Aetna today and verified that they have received and logged in the paperwork from the surgeon as of January 31 to review my Lap Band surgery approval. When I first asked how long did he (customer service rep) think it might be before I'd know if it was approved, he said 'gee, maybe 30 days depending on how backlogged we are" . I said Whoa! I've been working on all the medical clearances and things that Aetna requires for about 6 months now so I'm hoping it doesn't take that long. He said, well, call back in about 2 weeks if you haven't heard anything. I sure hope I get a call from the surgeon's office this week saying it went through in 3 days like some of you did!

lonestar5212 · 02-02-2008, 08:24 AM

SpecialK

Your paperwork and my paperwork got to Aetna at the same time! I got the 30 day answer also. I was very impressed with the 3 day answer some were lucky to get, but I told myself it would probably take at least 2 weeks. That way I won't lose my mind until then!! I am trying so hard to stay calm.
Good luck to you, and I will be waiting to see your post letting us all know you have received approval! Hang in there, this too shall pass, and we will be on our way.

Your Aetna experience?

so very frustrated

Aetna just approved me!